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FOR OFFICE: USE: APPLICATION FOR SANITATION PERMIT '' ........................................... Permit No: ..��7-= �-. (Complete in Triplicate) ....................................... Date Issued ...............7 _..................................... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..., � .---_.�Z�-. �� - f ../�.. ••.................CENSUS TRAC .. -37......... ; -----._ Owner's Name ....... ... ...••............• .... ........... hone ------••--- . - '. �` .-w_.... city - Address ... . �� ..---•.......................... Contractor's Name . License # 50� phone .............................. ... ,-- ----•�- •----- Installation will serve: Residence Apartment House Commercial ❑Trailer Court Q Motel ❑Other --------------------•-------------------••-- Number of living units:...... ... Number of bedrooms ____Garbage Grinder ............ Lot Size ...... ^' ``=-•-- Water Supply: Public System and name ------------------------------ .............................................. -----.....---••----• ........_....Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ - Peot❑ Sandy Loam E!r' Clay Loam ❑ *� Hardpan ❑ Adobe 0 Fill Material ............ If yes,type --------------- ------------ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public ewer is available within 200 feet,j PACKAGE TREATMENT SEPTIC TANKJPfc Size- ' '-a(_ ' .............. Liquid Depth .... ..................?`J Te 0 47 A�La Capacity �AOA;&-Ad... Type� *.k'. __..._ Material ..... No. Compartments ........ —----- ..- ; Distance to nearest: Well ----------- 1-04 ......Found ton.—A-42 ZJ Prop. Line LEACHING LINE (1] No, of Lines ------------- Length of each line----- Tota( Length ... 4r � .-------. 'D' Box Type Filter Materia( —4,4 ......Depth Filter Material .--------Pf.. .......................... Distance to nearest: Well ------�k ----.. l undation ..._/_.�? _..... Property Line ...- -- � Depth ./ � . ---- Sierrrr�ter __r1�.1.. Number ....... .................. Rock Filled Yes No Q ` ---: ........ Size Depth Distance to nearest: Well ...... ..............Foundation . ... Prop. Line _---- _._.•- REPAIR/ADDITION(Prev. Sanitation Permit# ....................................... Date .................................. Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ----•--•-•••------ -----------•--- ............----------------------------------------------=--------._.........._ ----------------- ----------- ---------------- ------------._..-------------------------------- ----------------------------.......................................................... ........................_........•--------------------- .................... (Draw existing and required addition on reverse side) - I hereby certify that I have prepared this application and that the work will be done in„accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health District. Herne owner or liten- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .. ....... ------------------ Owner By ... ........... .... ------------•--•• Title .. .. :•fly._ : :_.............__.........---- (if other than owner) ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6 ¢.. a...... ............................................... ................,.. DATE . �+.. .-.7..x,1 .............. BUILDING PERMIT ISSUED ---------------------------------------------------•---------------------------------- ._..•............•..DATE ........................................... ADDITIONALCOMMENTS .....................•-----------------•---------........------------------------ •.................................................. ................... --------------------------................... ............... ...............................................................------...................... .....................................I....-•. --------•------------- .. -. -----. Final Inspection by; •. . .. — .... ..,.. --6�- ...............................................Date .: ��:.7 -- .-..-... SAN JOAQUIN LOCAL HEALTH DISTRICT t 7/72 3 M